Managing lateral end clavicle fracture at a tertiary level hospital in India

Swaroop Solunke, Vivek Patole

Abstract

Background: With numerous methods and recommendations for managing fracture of lateral end of the clavicle, it always creates a clinical dilemma for the treating surgeon. This study is aimed to compare the functional outcome in patients with lateral end clavicle fracture treated either with operative and non-operative modalities.

Methods: This non-randomized comparative study was conducted at Department of Orthopedics, DY Patil Medical College, Pimpri between September 2017 till June 2018, in which all patients with lateral end clavicle fracture were included. Patients were managed either non-operatively or with precontoured locking compression plate was fixed with 4 mm locking screw or 3.5 mm cortical screw. At the final follow up (at least one year) patients’ functional outcome was assessed using the Constant and Murley score.

Results: A total of 57 patients were included in the study and 93% of the patients with operative management and 66% with non-operative treatment had a union time of 8 weeks or less. Out of the 27 patients who underwent non-operative treatment, three had malunion, two had non-union and five had deformity. Based on the Constant and Murley score, 27% of the patients in the operative group had an excellent outcome, and in the non-operative group, 8% had excellent functional outcome. The functional outcome was significantly better in the operative group (p=0.034).

Conclusions: A better understanding of the risk factors for nonunion would help us to make decision between operative and nonoperative treatment. Randomized trials comparing the operative and non-operative treatments would help in understanding the merits of one method over other.